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Early child development in England: cross-sectional analysis of ASQ®-3 records from the 2-2½-year universal health

Jayu Jung1, Sarah Cattan2, Claire Powell1

  • 1UCL Great Ormond Street Institute of Child Health, University College London, London, WC1N 1EH.

International Journal of Population Data Science
|March 26, 2025
PubMed

Insights

This study analyzed Ages & Stages Questionnaire 3rd Edition (ASQ®-3) data in England, finding 13.8% of two-year-olds may need developmental support. Data completeness requires improvement for accurate child development assessment.

Area of Science:

  • Child Development
  • Public Health
  • Data Science

Background:

  • The Ages & Stages Questionnaire 3rd Edition (ASQ®-3) is a US-developed tool for assessing child development in children aged 1-66 months.
  • ASQ®-3 data has been collected in England since 2015 within the Community Services Dataset (CSDS) during mandated health visiting reviews.
  • The Community Services Dataset (CSDS) is known for data incompleteness, with no prior published analyses of ASQ®-3 data within it.

Purpose of the Study:

  • To identify a complete subset of child development data for two-year-old children in England from the CSDS (2018/19-2020/21).
  • To analyze child development in two to two-and-a-half-year-olds in England using the identified complete ASQ®-3 data subset.
  • To estimate the proportion of children requiring developmental support and identify demographic disparities.

Main Methods:

  • Compared ASQ®-3 record counts in CSDS against national Health Visitor Service Delivery Metrics (HVSDM) to identify local authorities with complete data.
  • Utilized a subset of complete ASQ®-3 records from 64 local authorities (n=226,505 children).
  • Analyzed child development using both a binary outcome (meeting expected development) and continuous ASQ®-3 scores.

Main Results:

  • 86.2% of children in the analyzed sample met the expected level of development.
  • Children from deprived neighborhoods (82.6%), those recorded as Black (78.9%), and boys (81.7%) were less likely to meet developmental expectations.
  • The study estimates a minimum of 13.8% of children require developmental support.

Conclusions:

  • Improvement in the completeness of ASQ®-3 data within the CSDS is crucial for a comprehensive understanding of early child development in England.
  • Standardization and validation of the ASQ®-3 within the English context are recommended for accurate interpretation of national data.
  • The study highlights potential underestimation of developmental delays, as many children may experience milder delays not captured by current cut-offs.
Abstract

Keywords:
ages and stages questionnairechild developmentcommunity service datasetearly yearshealth visiting

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